Provider Demographics
NPI:1730309220
Name:WASHINGTON, LYNDA HARRIS (OTL)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:HARRIS
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 S 198TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-1370
Mailing Address - Country:US
Mailing Address - Phone:918-355-9530
Mailing Address - Fax:
Practice Address - Street 1:3000 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7917
Practice Address - Country:US
Practice Address - Phone:918-451-5143
Practice Address - Fax:918-451-5187
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOT38225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist